British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Intrathecal ropivacaine for total hip arthroplasty: double-blind comparative study with isobaric 7.5 mg ml(-1) and 10 mg ml(-1) solutions.
This study was designed to evaluate the efficacy and safety of two concentrations of intrathecal ropivacaine, 7.5 and 10 mg ml(-1), in patients undergoing total hip arthroplasty. One hundred and four patients, ASA I-III, were randomized to receive an intrathecal injection of one of two concentrations of isobaric ropivacaine. Group 1 (n=51) received 2.5 ml of 7.5 mg ml(-1) ropivacaine (18.75 mg). ⋯ The median duration of complete motor block was significantly prolonged (P<0.05) in Group 2 compared with Group 1 (1.9 vs 1.2 h, respectively). Anaesthetic conditions were excellent in all but one patient. Intrathecal ropivacaine, in doses of 18.75 and 25 mg, was well tolerated and provided effective anaesthesia for total hip arthroplasty.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison between dexmedetomidine and propofol for sedation in the intensive care unit: patient and clinician perceptions.
The alpha2 agonist dexmedetomidine is a new sedative and analgesic agent which is licensed in the USA for post-operative intensive care sedation. We compared dexmedetomidine with propofol in patients requiring sedation in intensive care. Twenty adult patients expected to require a minimum of 8 h artificial ventilation after surgery were randomized to receive sedation with either dexmedetomidine or propofol infusions. ⋯ From the clinician's and patient's perspectives, dexmedetomidine is a safe and acceptable sedative agent for those requiring intensive care. The rate pressure product is reduced in patients receiving dexmedetomidine, which may protect against myocardial ischaemia. Dexmedetomidine reduces the requirement for opioid analgesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Influence of equianaesthetic concentrations of nitrous oxide and isoflurane on regional cerebral blood flow, regional cerebral blood volume, and regional mean transit time in human volunteers.
Nitrous oxide and isoflurane have cerebral vasodilatory effects. The use of isoflurane in neuroanaesthesia is widely accepted, whereas the use of nitrous oxide in neuroanaesthesia is still the subject of debate. In the present study, contrast-enhanced magnetic resonance (MR) perfusion measurement was used to compare the effects of 0.4 MAC nitrous oxide (n=9) and 0.4 MAC isoflurane (n=9) on regional cerebral blood flow (rCBF), regional cerebral blood volume (rCBV) and regional mean transit time (rMTT) in spontaneously breathing human volunteers. ⋯ Isoflurane, by contrast, increased rCBF and rCBV in basal ganglia more than did nitrous oxide. An increased rMTT was caused by a relatively greater increase in rCBV than in rCBF supratentorially by isoflurane and infratentorially by nitrous oxide. In conclusion, nitrous oxide increases rCBF and rCBV predominantly in supratentorial grey matter, whereas isoflurane increases rCBF and rCBV predominantly in infratentorial grey matter.
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We present a case of a probably unnecessary Caesarean section due to misinterpretation of the cardiotocography (CTG) trace during general anaesthesia. A 27-yr-old patient in her 30th week of an uneventful, normal first pregnancy presented with a deep venous thrombosis in the pelvic region. She was to undergo an emergency thrombectomy under general anaesthesia. ⋯ The pH at delivery was 7.23 and the baby was extubated 2 days later. Mother and child recovered without short-term sequelae. In the absence of alternative explanations, reduced fetal beat-to-beat variability with a normal baseline heart rate during general anaesthesia is probably normal.